Making the Most of the Stroke Rehabilitation Team

Stroke rehabilitation professionals

When someone has a stroke, you can aid in his recovery not just by supporting him emotionally and physically but by helping to choose and coordinate the stroke rehabilitation team. Here are six ways to do it.

1. Get to know the team members

A stroke survivor will have a team of specialists dedicated to his rehabilitation. His team may include some or all of the following members:

  • You. Of all the members of his team, as the caregiver, you're the one who probably understands him best. Depending on how much time you can devote to his rehabilitation, your role may range from providing support to coordinating meetings between other team members. At the very least, your care and support can be one of the most positive factors in his rehabilitation.
  • Case manager. A good case manager is an invaluable resource. This person serves as the liaison between you and other members of the rehabilitation team and helps you deal with the patient's insurance company. The case manager should also be able to help you find support groups, information about finances, and legal assistance if necessary. Most often, the hospital assigns a social worker to manage the case, but these people are notoriously overworked. If you can't get the help you need from the hospital social worker, you may want to consider hiring an independent care manager. Ask the social worker for a referral, and be sure to check the care manager's references.
  • Lead physician. A patient's doctor is responsible for managing his care and rehabilitation. In the hospital, the lead physician may be a neurologist or an internist. Once a stroke survivor is discharged, he may be referred to a physiatrist, a doctor who specializes in rehabilitation. In either case, this person will arrange medical care, manage medication, and oversee the other therapists.
  • Rehabilitation nurses. In the hospital and rehabilitation center, nurses will tend to a stroke survivor's everyday medical needs and personal hygiene. They can teach you how to care for him at home, showing you how to avoid pressure sores, transfer him in and out of bed, deal with incontinence, and help him avoid another stroke.
  • Physical therapist. The physical therapist will focus on his motor functions: strength, endurance, walking or wheelchair use, balance, and coordination. Once a stroke survivor returns home, the physical therapist may design an exercise program he can follow between sessions.
  • Occupational therapist. Like the physical therapist, the occupational therapist will help with a stroke survivor's motor functions, but the emphasis is on normal daily routines. Known as "activities of daily living," these include personal hygiene, getting dressed, using the toilet -- any activity that's part of a person's normal day. For example, if the person you're caring for has lost his left visual field, the occupational therapist will work on teaching him to scan for objects on the left side. The occupational therapist can also recommend home modifications and assistive devices that may enable him to live more independently.
  • Speech therapist. If a stroke survivor has any language deficits, a speech therapist can help him relearn how to speak or teach him to communicate in other ways. This therapist can also help him work on his cognitive abilities (such as problem solving, decision making, and social skills). Finally, she can help him overcome swallowing difficulties.
  • Clinical dietitian. Along with swallowing problems, stroke survivors may have incontinence and excessive weight loss. A dietitian will address his specific nutritional needs and can recommend a low-sodium, heart-healthy diet to help prevent future strokes.
  • Rehabilitation counselor. A rehabilitation counselor focuses on the emotional aftermath of a stroke, as well as issues that arise during rehabilitation. This counselor will address any depression, anxiety, or behavioral problems. The counselor should also work with you and family members, offering strategies for helping the stroke survivor and even suggestions for managing your own stress.

A good environment for stroke rehabilitation

2. Choose the right setting

Rehabilitation starts in the hospital, as soon as a patient is stable. After two to four weeks of intense inpatient rehabilitation, his team will recommend what step to take next.

  • Skilled nursing facility. This type of facility is for patients who are too disabled for rehabilitation in another setting. If someone is too weak or sick to return home or to an assisted living facility , he may need to go to a skilled nursing facility, at least temporarily.
  • Outpatient rehabilitation. This is an option for stroke survivors who are able to live on their own, in an assisted living facility, or in their families' homes. A patient will go to a hospital or separate clinic for his various therapies. Most outpatient programs have patients come in three days a week, but some are more intensive.
  • Home-based rehabilitation. This process usually follows the completion of an outpatient program and focuses on teaching a patient to function in his own home. Alternatively, it's an option if he comes to a family member's home instead of a nursing facility but is too disabled for an outpatient program.

Which rehabilitation setting you choose depends on a number of factors, including the extent of the patient's disability, his finances, his living situation, and the location of the facility. Also take into account your personal impressions of the rehabilitation center and staff. Visit the rehabilitation center, interview the staff, and observe what's going on with other patients. Ask questions and take notes. You can print out these checklists or make your own to bring with you:

Is the facility clean?
Is the equipment up-to-date?
Is the facility in a convenient location?
Is parking easy?
Is the facility CARF-accredited * ?
Is there a doctor on site?
What's the plan of action for medical emergencies?
Does this see m like a good environment?

* Check the website for the Commission on Accreditation of Rehabilitation Facilities (CARF) or call CARF at 520-325-1044 to find out if a facility is accredited.

Other Considerations
What percentage of patients have had a stroke or traumatic brain injury?
What's the average stay for a stroke survivor?
What percentage of patients go home and what percentage go to a nursing facility?
What's the average age of the other patients?

Once you've chosen a rehabilitation facility, keep in mind that it's not an irreversible decision. If the patient doesn't seem to be progressing, you can always revisit your selection.

Your role and knowing what to expect of stroke rehabilitation

3. Actively participate -- if you can

As a caregiver, you may be able to help by taking an active role in his rehabilitation. Having a caring and supportive person or family member around can make a world of difference. After all, you may be the one person on his team who knows what he was like before the stroke.

But it might not be possible for you to oversee his therapy. Other obligations, such as work or small children, may already take up most of your time. Or perhaps your relationship with the patient -- especially if it's a parent -- is strained and neither of you would benefit from your presence at his appointments. Talk to his care manager and counselor about how involved you can be in his rehabilitation. And try not to feel guilty if you're not able to play a major role: You have your own life, too.

4. Understand the goals of rehabilitation

It's important for you and the person you're caring for to understand that rehabilitation isn't a magical cure. The ultimate goals are to help him regain as much independence as he can and have the best quality of life possible.

In their book Living with Stroke: A Guide for Families , Richard Senelick and Karla Dougherty discuss how realistic rehabilitation goals can make all the difference. Although dead brain cells can't be revived, rehabilitation can teach a patient how to cope with his losses and move forward. A good rehabilitation team should:

  • Evaluate a stroke survivor's needs continuously and adjust his rehabilitation plan accordingly
  • Watch out for and prevent medical complications
  • Provide a structured, consistent, and secure environment
  • Teach strategies to compensate for lost abilities
  • Encourage progress and focus on the po sitive
  • Stress practical, everyday activities

Be realistic and upbeat during stroke rehabilitation

5. Have realistic expectations

One of the most difficult aspects of stroke recovery to grapple with is the uncertainty. The course of a patient's re habilitation probably won't be steady; most stroke survivors have periods of rapid progress punctuated by plateaus. And it's impossible to predict what the future will hold.

That said, if you expect him to recover completely, you're probably setting yourself up for disappointment. Talk to the members of the rehabilitation team about his prognosis for recovery. And don't just talk to them about it once: Revisit the subject every few months. One thing that's certain is that rehabilitation is a fluid process. You, the person in your care, and the rest of the rehabilitation team should expect to reevaluate his program -- and your expectations -- on a regular basis.

6. Try to stay positive

It's normal to mourn for what's been lost, but everyone also has to move forward. Encourage the patient to do his exercises and make the most of his therapy appointments. Celebrate his successes, no matter how small. Although it's not easy to maintain a cheerful disposition in the face of such a difficult situation, your positive outlook will rub off on the person you're caring for.

Of course, it's impossible to be positive and upbeat at all times. But bottling up your feelings of anxiety and sadness will ultimately take a toll on your own physical and emotional health. Joining a support group for stroke caregivers might give your emotions an outlet and allow you to connect with other caregivers. For more information on finding a support group, see " 5 Ways to Connect with Other Stroke Caregivers. "


Stephanie Trelogan

Stephanie Trelogan writes about heart disease, stroke, and depression issues that concern people caring for their aging parents. See full bio